Incident Report Template for New Zealand

Complete an Incident Report immediately after any workplace accident, injury, near-miss, or health and safety breach occurs. This includes situations like equipment failures, chemical spills, falls, vehicle incidents, or when someone needs first aid or medical attention. File the report while memories are fresh and evidence is available.

Time-sensitive reporting helps meet WorkSafe NZ requirements and supports ACC claims processing. Quick documentation also protects your organization during investigations, helps identify hazard patterns, and provides vital information for preventing similar incidents. For serious harm incidents, notify WorkSafe NZ within 24 hours and follow up with detailed documentation as required by the Health and Safety at Work Act.

• Health And Safety Incident Report Form: Core template for general workplace accidents and injuries, aligned with WorkSafe NZ requirements
• Incident Investigation Form: Detailed format for thorough analysis of serious incidents, focusing on root cause identification
• Work Place Injury Report Form: Specialized for ACC claims and medical treatment documentation
• Security Incident Report Form: Tailored for security breaches, theft, or unauthorized access events
• Incident Response Form: Focuses on immediate actions taken and emergency response procedures

• Health and Safety Officers: Lead the incident reporting process, conduct initial assessments, and ensure proper documentation meets WorkSafe NZ standards
• Employees: Report incidents they witness or experience, provide detailed accounts, and participate in follow-up investigations
• Managers and Supervisors: Review reports, implement corrective actions, and maintain departmental safety compliance records
• HR Departments: Process injury-related leave, coordinate with ACC, and manage return-to-work arrangements
• WorkSafe NZ Inspectors: Review incident documentation during site visits and investigate serious harm incidents
• ACC Case Managers: Assess injury reports for compensation claims and rehabilitation support

• Basic Details: Record date, time, location, and names of all people involved in the incident
• Incident Description: Document exactly what happened, including events leading up to the incident and immediate aftermath
• Evidence Collection: Take photos, gather witness statements, and secure any relevant CCTV footage or equipment records
• Medical Information: Note any injuries, first aid provided, and medical treatment sought
• Contributing Factors: List environmental conditions, equipment status, and any workplace procedures involved
• Immediate Actions: Detail steps taken to secure the scene and prevent further incidents
• Follow-up Measures: Outline corrective actions, training needs, and prevention strategies

• Incident Identification: Unique reference number, date, time, and specific location details as required by WorkSafe NZ
• Party Information: Full names and roles of all involved persons, witnesses, and reporting staff member
• Incident Classification: Clear categorization under Health and Safety at Work Act 2015 criteria
• Factual Description: Objective account of events without speculation or blame assignment
• Injury Details: Nature and severity of any harm, treatment provided, and ACC claim references
• Control Measures: Existing safety protocols and any immediate corrective actions taken
• Authentication: Dated signatures of the reporter, supervisor, and health and safety representative

While an Incident Report documents accidents and safety events after they occur, an Incident Response Plan outlines how your organization will handle future incidents. These documents work together but serve different purposes in your health and safety framework.

• Timing and Purpose: Incident Reports are reactive, documenting specific events that have already happened. Response Plans are proactive, establishing procedures before incidents occur
• Content Focus: Reports detail facts, evidence, and immediate actions taken. Plans outline roles, responsibilities, and step-by-step response procedures
• Legal Requirements: Reports fulfill WorkSafe NZ notification obligations and ACC documentation needs. Plans demonstrate compliance with risk management obligations under the Health and Safety at Work Act
• Usage Pattern: Reports are completed for each incident. Plans are reviewed annually or after major incidents to update procedures